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General NPI Number Information
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NPI Number | 1588797393
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Entity Type | Organization
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Legal Business Name | MONA ISSA CHIROPRACTIC AND WELLNESS CENTER
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11200 PINES BLVD #101
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-4139
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Country | US
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Telephone | 954-880-0101
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Fax |
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Provider Business Mailing Address
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Address Line | 11200 PINES BLVD #101
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-4139
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Country | US
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Telephone | 954-880-0101
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MONA ISSA
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Credential | D.C., P.A
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Telephone | 954-880-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH8219
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License Number State | FL
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